Specialist Network Provider Manager

About the position

Well-established company based in Johannesburg North seeks a Specialist Network Provider Manager to join their team!
Requirements:

• Diploma or Degree (NQF Level 5 or higher)
• 1–2 years of relevant experience, preferably in healthcare or insurance
• Strong interpersonal, negotiation, and communication skills
• Knowledge of healthcare regulations, claims processing, and contracting
• Analytical, organized, detail-oriented, and able to manage multiple tasks
• Proficient in MS Office and basic computer applications

Responsibilities:

• Provider Network Management:Build, negotiate, and maintain a network of medical specialists. Handle contracts, rate negotiations, and provider communications.
• Strategy & Analysis:Identify gaps in provider networks and implement strategies to enhance efficiency and coverage. Monitor return on investment of network initiatives.
• Claims & Risk Management:Oversee claims processes to ensure compliance with agreed terms. Resolve provider disputes and discrepancies.
• Performance Monitoring:Track provider performance and key metrics. Report outcomes and recommend improvements.
• Compliance & Quality Assurance:Ensure providers follow relevant regulations and quality standards. Conduct audits and stay updated on industry regulations.
• Customer Service & Support:Act as a main contact point for providers, addressing queries and concerns professionally.
• Training & Development:Educate network providers on procedures, standards, and updates.

Desired Skills:

• Healthcare Provider Network Specialist
• Medical Network Manager
• Provider Relations Specialist
• Managed Care Network Coordinator
• Healthcare Network Contract Specialist